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In a far corner of India, nurses provide family planning services to women despite a pandemic

By Krithika Murali

Nurse Akumla had studied, worked and sacrificed so much, all to ensure that underserved women living in one of India’s most remote and rugged regions—Longleng district in the far northeastern state of Nagaland—have access to safe reproductive health services.

Her efforts, which involved arduous travel that kept her away from her own home and husband, were paying off. Women who had been unaware of contraceptive options started to avail themselves of her services, including insertion of intrauterine contraceptive devices (IUCDs). Couples whose traditional beliefs made them wary of family planning had become interested in what she had to say and provide. Her evidence-based reasoning impressed those who heard her explain that family planning benefits not only the health of mothers, but also babies, as well as the wellbeing of entire families and communities.

Then came the novel COVID-19.

Akumla had good reason to fear that the hard-won progress made since she was first posted in September 2019 as a community health officer (CHO) at Ayushman Bharat Health and Wellness Center (AB-HWC) would be lost.

Nationwide lockdowns announced in March disrupted economies, transportation and other essential health services, including family planning. Access to and use of contraception was compromised. Government advisories caused public facilities to temporarily suspend the provision of sterilizations and IUCDs.

Still, Akumla did not lose hope. Despite the fact that she was expecting—in her first trimester—in the early days of the pandemic, she made regular home visits to deliver key COVID-19 messages and counsel families to adopt healthy behaviors. In addition to offering essential health services, she also distributed contraceptives to eligible couples.

She often walked for long distances to make the house calls, and lived away from her own family, visiting her husband only during weekends.

“Serving my community and my people is what gives me joy,” Akumla says. “This is what drove me to do my work every day.”

After the lockdown was relaxed, Akumla eagerly resumed providing IUCD services at AB-HWC.

When a 35-year-old woman visited her at the facility for health services for her child, she told Akumla she had been pregnant eight times, but only five daughters survived. Akumla counseled the woman on the basket of contraceptive choices available and explained the benefits of family planning to the woman and her husband. As a result, the young couple returned to the center the next day, having decided that an IUCD was right for their family. Akumla skillfully performed the insertion, following all precautionary and infection control measures. She then conducted regular follow-up visits to ensure the woman was healthy and safe.

Funded by the U.S. Agency for International Development, the NISHTHA: Transforming Comprehensive Healthcare in India project is empowering CHOs like Akumla by building their capacity to provide reproductive, maternal, child and newborn health services through technical support for the Certificate Course in Community Health—a six-month course for CHOs that Akumla completed in September 2019. Implemented by Jhpiego, NISHTHA provides technical assistance to the national government and 12 state governments in implementing the country’s health and wellness centers under the world’s largest comprehensive primary health care program, Ayushman Bharat.

NISHTHA is also training CHOs like Akumla to equip them with the right knowledge and skillset to respond to the COVID-19 pandemic.

Akumla is one of countless CHOs working around the clock to ensure that every woman—no matter who they are or where they live—has access to safe reproductive health services, even amid a global pandemic.

Rapungna Pairson, Program Officer in Jhpiego’s India office, contributed to this story.